Respircase Cilt: 4 - Sayı: 1 Yıl: 2015

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Respiratory Case Reports other patients and was started on a combination therapy of a bronchodilator and steroid. The patients were informed about the occupational exposure to and the protective methods against the causative agents, and were put under close clinical and radiological follow-up. Figure 5: The third patient’s chest x-ray is consistent with marked linear reticular densities and millimetric nodules in the upper lobes of both lungs Figure 6: The third patient’s thoracic computed tomography demonstrates a diffuse micronodular appearance with patchy ground glass density, as well as soft tissue appearances, suggesting massive fibrosis in the upper lobes of both lungs DISCUSSION Dental technicians are exposed to many types of chemical dusts. The advance of novel dental materials increases the potential risk of respiratory involvement. It is problematic to establish a solid link between pneumoconiosis and other lung pathologies and exposure to a single dust. Studies have attempted to determine the etiology of the disease by determining the tissue metal dust level, either from BAL fluid (5) or lung biopsy (6). In this study we did not perform such studies since they would not alter the diagnostic and therapeutic decisions of our patients. All three patients had normal cell distribution in the BAL fluid. No specific biopsy finding could be obtained, either. The prevalence of pneumoconiosis is related to the duration of the exposure to causative agent. Epidemiological studies have revealed exposure to toxic agents for over 20 years results in a technician’s pneumoconiosis prevalence of 15% (7). The prevalence of the disease has been reported in variable numbers, possibly due to different study conditions and population characteristics. Dyspnea, cough, and sputum expectoration are the most common symptoms of dental technician’s pneumoconiosis. However, not all symptoms of the disease are necessarily found in a given patient (8). The first patient demonstrated a minimal reduction in the respiratory function, which was likely intensified by cigarette smoking. Former studies on respiratory function in dental technician’s pneumoconiosis have yielded variable results. Froudarakis et al. (9) reported no significant loss in respiratory function, while Choudat et al. (2) showed significant decreases in all mean indices of lung function, particularly in smokers. As for the exercise capacity, we also observed a decrease in walking distance in the first case. The limitation of exercise capacity has been linked to loss of respiratory function. Exercise tests should also be used as supplementary tests to respiratory function tests in the assessment of pneumoconiosis cases. Dental technicians are reportedly at risk for autoimmune disorders (2). Some previous studies demonstrated increased autoantibodies in dental technician’s pneumoconiosis and suggested a connection with connective tissue disorders. Nevertheless, our cases had normal autoantibody levels. Bilateral nodular lesions are the most common lesions observed in dental technician’s pneumoconiosis. ILO scores are used to assess radiological extent and severity (10). Both ILO profusion scores and HRCT scores showed a positive correlation with employment duration and thus exposure to causative chemical agents. In an ever-widening dental supply market, dental technicians are increasingly vulnerable for exposure to occupational health hazards. In addition to the introduction of new dental materials, there is an ever-growing need for occupational health practitioners to be aware of the work processes used, to recognize possible hazards, and to implement appropriate preventive measures to protect the workers’ health in this profession. Dental laboratories must have excellent ventilation and enclosure systems to prevent exposure to airborne contaminants (11-13). In conclusion, dental technician’s pneumoconiosis is a preventable type of pneumoconiosis that is related to the <strong>Cilt</strong> - Vol. 4 <strong>Sayı</strong> - No. 1 8
A Review of Dental Technician’s Pneumoconiosis: Three Case Reports | Çiftçi et al. length of occupational exposure. Air flow limitation may be observed in this disorder and it may be more prominent in smokers. In symptomatic cases, exercise capacity should also be evaluated. Radiological modalities have an important diagnostic role for this entity. Dental technicians can be protected against this disorder by informing them about occupational lung diseases and taking preventive measures. CONFLICTS OF INTEREST None declared. AUTHOR CONTRIBUTIONS Concept - F.Ç., A.G.K., A.Ç., A.K.; Planning and Design - F.Ç., A.G.K., A.Ç., A.K.; Supervision - F.Ç., A.G.K., A.Ç., A.K.; Funding - F.Ç., A.G.K., A.Ç., A.K.; Materials - F.Ç., A.G.K., A.Ç., A.K.; Data Collection and/or Processing - F.Ç., A.G.K., A.Ç., A.K.; Analysis and/or Interpretation - F.Ç., A.G.K., A.Ç., A.K.; Literature Review - F.Ç., A.G.K., A.Ç., A.K.; Writing - F.Ç., A.G.K., A.Ç., A.K.; Critical Review - F.Ç., A.G.K., A.Ç., A.K. YAZAR KATKILARI Fikir - F.Ç., A.G.K., A.Ç., A.K.; Tasarım ve Dizayn - F.Ç., A.G.K., A.Ç., A.K.; Denetleme - F.Ç., A.G.K., A.Ç., A.K.; Kaynaklar - F.Ç., A.G.K., A.Ç., A.K.; Malzemeler - F.Ç., A.G.K., A.Ç., A.K.; Veri Toplama ve/veya İşleme - F.Ç., A.G.K., A.Ç., A.K.; Analiz ve/veya Yorum - F.Ç., A.G.K., A.Ç., A.K.; Literatür Taraması - F.Ç., A.G.K., A.Ç., A.K.; Yazıyı Yazan - F.Ç., A.G.K., A.Ç., A.K.; Eleştirel İnceleme - F.Ç., A.G.K., A.Ç., A.K. REFERENCES 1. Torbica N, Krstev S. World at work: Dental laboratory technicians. Occup Environ Med 2006; 63:145–8. [CrossRef] 2. Choudat D, Triem S, Weill B, Vicrey C, Ameille J, Brochard P, et al. Respiratory symptoms, lung function, and pneumoconiosis among self-employed dental technicians. Br J Ind Med 1993; 50:443-9. [CrossRef] 3. Kahraman H, Koksal N, Cinkara M, Ozkan F, Sucaklı MH, Ekerbicer H. Pneumoconiosis in dental technicians: HRCT and pulmonary function findings. Occup Med (Lond) 2014; 64:442-7. [CrossRef] 4. Ollagnier C, Tolot F, Perrin LF, Bognard G. Une observation de silicose chez un mécanicien dentiste. Arch Mal Prof 1962; 23:385–6. 5. Collins A, Burhan H, Davies P. Dental workers' pneumoconiosis complicated by Mycobacterium aviumintracellulare complex (MAIC) infection. Occup Environ Med 2011; 68:82. [CrossRef] 6. Kartaloglu Z, Ilvan A, Aydilek R, Cerrahoglu K, Tahaoglu K, Baloglu H, et al. Dental technician's pneumoconiosis: mineralogical analysis of two cases. Yonsei Med J 2003; 44:169-73. [CrossRef] 7. Berk S, Dogan DO, Gumus C, Akkurt I. Relationship between radiological (X-ray/HRCT), spirometric and clinical findings in dental technicians' pneumoconiosis. Clin Respir J 2014 (in press). [CrossRef] 8. Cimrin A, Kömüs N, Karaman C, Tertemiz KC. Pneumoconiosis and work-related health complaints in Turkish dental laboratory workers. Tuberk Toraks 2009; 57:282- 8. 9. Froudarakis ME, Voloudaki A, Bouros D, Drakonakis G, Hatzakis K, Siafakas NM. Pneumoconiosis among Cretan dental technicians. Respiration 1999; 66:338-42. [CrossRef] 10. International Labour Organization (ILO). Guidelines for the use of ILO international classification of radiographs of pneumoconioses, revised edition 2000. Geneva: International Labour Office; 2002. 11. Abakay A, Atılgan S, Abakay O, Atalay Y, Guven S, Yaman F, et al. Frequency of respiratory function disorders among dental laboratory technicians working under conditions of high dust concentration. Eur Rev Med Pharmacol Sci 2013; 17:809-14. 12. Radi S, Dalphin JC, Manzoni P, Pernet D, Leboube MP, Viel JF. Respiratory morbidity in a population of French dental technicians. Occup Environ Med 2002; 59:398– 404. [CrossRef] 13. Brancaleone P, Weynand B, De Vuyst P, Stanescu D, Pieters T. Lung granulomatosis in a dental technician. Am J Ind Med 1998; 34:628–31. [CrossRef] 9 www.respircase.com
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